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S A N 1 Q A Q U I N Environmental Health Depai tment COUI`ITY-- TEMPORARY FOOD VENDOR'S APPLICATION All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three(3)weeks prior to this event. 1. 1.Name of Event: Lodi Street Fair Date(,): 5/4/25 and 10/5/25 2. The fallowing is information about my organizationlbusiness: Name of organizadon/business: FREEZYFROSTYLLC Address: 79 N Menlo Park St Mountain House Ca 95391 Phone: ( 209.) 321-1817 Alternate: ( ) 3. List food to be sold or given to the publicFreeze dried candy- freeze dried fruit- Freeze dried vegetables 4. 1 am providing food that is NOT prepared at home:❑Yes L-)No All food is prepared en-site or is from approved commercial facilities:❑Yes❑No Name of facility: FREEZYFROSTYLLC Phone: ( ) 209-321-1818 Address of facility: 79 N Menlo Park St MH CA 95391 5. 1 am providing a booth with the following:(to protect my unpackaged food and food-preparation areas from flies, dust and the public) ®A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparalion areas from the public. [�Other{specify}: Pre Packaged Food COTTAGE FOOD OPERATIONS Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers,or prepackaged foods from approved sources. 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods'. ❑Approved bottled water. ❑On-site hose bib that is connected to a potable water source. ❑ Other(specify): 7. Electricity is provided for my booth's use: ❑Yes❑No 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: ❑Yes❑ No 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: ❑Camp stove ❑Sterna,&hotel trays ❑ Double steamer ❑Steam table&lids ❑ Electric stove top ❑Other(specify) Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables, potato salad,eggs,and dairy products. 1868 E. Hazeltcn Avenue I Stockton, California 05205 1 T 209 468-3420 l F 209 464-0138 1 www.sjcehd.com �HQ 15-02 Page7 of 11 TEMP EVENTAPP 0713117